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This is VAERS ID 545805

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2014

545805
VAERS Form:
Age:0.2
Gender:Male
Location:Illinois
Vaccinated:2014-09-18
Onset:2014-09-26
Submitted:2014-09-30
Entered:2014-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4537AAC4502AA / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. J007946 / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H86640 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB430A / 0 - / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasoud: intussusception on 9/26/14 at hospital; transferred to another hospital for peds radiology reduction by enema
CDC 'Split Type':

Write-up:Vomiting for one day; intussusception diagnosed.


Changed on 2/14/2017

545805 Before After
VAERS Form:
Age:0.2 0.18
Gender:Male
Location:Illinois
Vaccinated:2014-09-18
Onset:2014-09-26
Submitted:2014-09-30
Entered:2014-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4537AAC4502AA / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. J007946 / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H86640 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB430A / 0 - / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasoud: intussusception on 9/26/14 at hospital; transferred to another hospital for peds radiology reduction by enema
CDC 'Split Type':

Write-up:Vomiting for one day; intussusception diagnosed.


Changed on 9/14/2017

545805 Before After
VAERS Form:(blank) 1
Age:0.18
Gender:Male
Location:Illinois
Vaccinated:2014-09-18
Onset:2014-09-26
Submitted:2014-09-30
Entered:2014-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4537AAC4502AA / 0 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. J007946 / 1 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H86640 / 0 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB430A / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasoud: intussusception on 9/26/14 at hospital; transferred to another hospital for peds radiology reduction by enema
CDC 'Split Type':

Write-up:Vomiting for one day; intussusception diagnosed.


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